Quebec Releases Report on Euthanasia
On December 8, 2021, the National Assembly of Quebec tabled the “Report on the evolution of the law concerning end of life care.”[1] The committee was mandated to study issues related to the expansion of medical assistance in dying (MAiD) for people who are incapacitated by their illness or suffering from mental disorders. In particular, they looked at the possibility of advance requests, eligibility for those with mental disorders, and what kind of criteria would guide the expansion of MAiD for people within these groups. The review included consultations with the public, experts, and other organizations.
This is the first official government review of medical assistance in dying legislation since the passage of Bill C-7 in March 2021. An expert panel appointed by the federal government is also expected to provide recommendations to the government by March 2022, specifically related to MAiD for those suffering from mental illnesses.
The committee raised serious concerns about the effects of MAiD, especially for those struggling with mental illness, and provided recommendations for moving forward.
Advance Requests
The first issue the committee studied was advance requests. This is when people can outline certain circumstances under which they would want to receive MAiD if they lose their ability to consent. If they do lose decision-making capacity, MAiD can be provided to them without any further request or consent to the procedure. Advance requests are not currently permitted in Canada but are also being studied by the federal government.
The committee considered serious concerns around advance requests, such as family members who choose to act in their own best interest rather than the best interest of the person who is incapacitated. Additionally, the committee considered concerns about external pressures to choose MAiD and the inability to confirm consent after the patient has lost the ability to consent. There are also patients who fear being a burden on society and those around them, choosing MAiD as a result. Finally, they considered whether allowing MAiD for those who are incapacitated devalues their lives. Those with disorders that will eventually cause them to be incapacitated might feel that their lives are not worth living because they have been deemed eligible for MAiD.
The committee states that the solutions to many of these issues are somewhat unclear. However, they conclude that with various safeguards and medical directives, advance requests should be an option for eligible patients. Despite the potential for harm and abuse of vulnerable people, there is pressure to expand Canadian law in this way.
Mental Illness
The other issue the committee studied was whether individuals whose only medical problem is a mental disorder should be eligible for medical assistance in dying. Canadians with mental illness are not currently eligible for MAiD. However, unless the existing law is changed, they will be eligible by March 2023. The conclusions of the committee on this issue were much more encouraging.
Much of the discussion surrounding MAiD for mental illness lies around the question of whether mental illnesses are incurable or irreversible. The committee reports that, for many, their condition might seem hopeless, but they can cope with their illness after receiving appropriate treatment. Ultimately, the committee concludes that “there is no clear medical consensus on incurability of mental disorders and the associated irreversible decline in abilities” (p. 51). Many experts point out that psychiatry is constantly developing and that new treatment options are being developed for mental illness.
The committee was also concerned about mental illness and related suicidal ideation in the context of MAiD. They report that we need “to offer suicide prevention services as soon as possible to anyone who needs it. As a society, we have a duty to support people struggling with suicidal thoughts and support the organizations that support them” (p. 54). Many organizations who presented to the committee also argued that patients with mental illness need to have hope that their illness can be overcome. Presenting them with the option of MAiD may extinguish any hope they might have and cause them to want to die. Expanding MAiD for mental illness “could send the signal that death is a legitimate option or even suitable for people with mental disorders. We would thus undermine decades of suicide prevention efforts. Such effects are difficult to assess, but they deserve further reflection” (p. 56).
Overall, the committee expressed concern about the lack of consensus in the medical community on this issue, the harmful effect that expanding MAiD into the area of mental health would have on patients, and the major risk of abuses. The committee concludes their discussion on mental illness with the following recommendation: “The Commission recommends not expanding access to medical assistance in dying for people whose only medical problem is a mental disorder” (p. 58). The primary reasons given are the lack of consensus on whether mental illnesses are incurable, lack of social acceptability on the issue, the difficulty and length of time it takes to establish an accurate diagnosis of mental illness, and the fear that those with mental illness would choose death rather than treatment and supports which would help relieve their suffering.
Conclusion
When the federal government passed Bill C-7, ARPA Canada, along with multiple other organizations and individuals, expressed many of the same concerns that are presented by the committee in this report.
It is good to see an official government report recommending that MAiD should not be expanded to those who struggle with mental illness. We hope and pray that the expert panel appointed by the federal government to study the issue will recommend the same, and that the government will improve the law by removing eligibility for mental illness. We also hope that federal and provincial governments will more seriously consider the harm caused by pushing for expansion through advance requests.
[1] The original report is written in French. Any direct quotes are provided with the help of Google Translate.
